Bottom Line:
These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools.Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents.Conflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a "one-size-fits-all" approach.

Background: Disruptive behavior among hospital staff can negatively affect quality of care. Motivated by a standard on disruptive behavior issued by The Joint Commission (LD 3.10), as well as the desire to improve patient care, minimize liability, and improve staff retention, hospitals are setting policies to prevent and resolve disruptive behaviors. However, it is unknown whether uniform conflict management tools are equally effective among different hospital settings.

Methods: We surveyed residents and nurses to identify similarities and differences among hospital departments in the antecedents, characteristics, and outcomes of disruptive behaviors, and in the effectiveness of conflict management tools. We used a quantitative questionnaire-based assessment to examine conflict perceptions in eight different hospital departments at Rambam Medical Center in Haifa, Israel.

Results: Most participants (89 %) reported witnessing disruptive behavior either directly or in other parties; the most significant causes were identified as intense work, miscommunication, and problematic personalities. The forms of these behaviors, however, varied significantly between departments, with some more prone to expressed conflicts, while others were characterized by hidden disruptive behaviors. These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools. Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents. Other tools, however, are antecedent-specific, falling into two principal categories: tools directly removing a specific problem and tools that offer a way to circumvent the problem.

Conclusions: Conflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a "one-size-fits-all" approach.

Fig4: Consequences of disruptive behavior. a Average scores of questionnaire on a scale of 1–5 for different Consequences of disruptive behaviors, for all participants (grey) and dissected by department (color, see legend; LD: Labor and Delivery, ICU: Intensive Care Unit, ER: Emergency Room, ECU: Emergency Care Unit). Error bars are calculated as explained in Fig. 1. b Clustering algorithm (left dendogram) applied to the correlation matrix between each two Consequences of disruptive behavior (color-map represent the correlation; red – high correlation, yellow- low correlation) reveals natural grouping of the Consequences into ‘Medical’, ‘Personal’ and ‘Patient’ effects. See text for more details

Mentions:
Nurses and residents perceived that both patients and staff were negatively affected by disruptive behavior (Fig. 4a). The two most scored consequences of disruptive behavior represented a negative impact on both patients and staff. The first rated consequence was stress and frustration – which affected the staff. The second most commonly perceived consequence of disruptive behavior was a negative impact on patient satisfaction. The more severe results of disruptive behavior - medical mistakes and adverse events- appeared to be linked with disruptive behavior between nurses and physicians, but with a significantly lower frequency.Fig. 4

Fig4: Consequences of disruptive behavior. a Average scores of questionnaire on a scale of 1–5 for different Consequences of disruptive behaviors, for all participants (grey) and dissected by department (color, see legend; LD: Labor and Delivery, ICU: Intensive Care Unit, ER: Emergency Room, ECU: Emergency Care Unit). Error bars are calculated as explained in Fig. 1. b Clustering algorithm (left dendogram) applied to the correlation matrix between each two Consequences of disruptive behavior (color-map represent the correlation; red – high correlation, yellow- low correlation) reveals natural grouping of the Consequences into ‘Medical’, ‘Personal’ and ‘Patient’ effects. See text for more details

Mentions:
Nurses and residents perceived that both patients and staff were negatively affected by disruptive behavior (Fig. 4a). The two most scored consequences of disruptive behavior represented a negative impact on both patients and staff. The first rated consequence was stress and frustration – which affected the staff. The second most commonly perceived consequence of disruptive behavior was a negative impact on patient satisfaction. The more severe results of disruptive behavior - medical mistakes and adverse events- appeared to be linked with disruptive behavior between nurses and physicians, but with a significantly lower frequency.Fig. 4

Bottom Line:
These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools.Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents.Conflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a "one-size-fits-all" approach.

Background: Disruptive behavior among hospital staff can negatively affect quality of care. Motivated by a standard on disruptive behavior issued by The Joint Commission (LD 3.10), as well as the desire to improve patient care, minimize liability, and improve staff retention, hospitals are setting policies to prevent and resolve disruptive behaviors. However, it is unknown whether uniform conflict management tools are equally effective among different hospital settings.

Methods: We surveyed residents and nurses to identify similarities and differences among hospital departments in the antecedents, characteristics, and outcomes of disruptive behaviors, and in the effectiveness of conflict management tools. We used a quantitative questionnaire-based assessment to examine conflict perceptions in eight different hospital departments at Rambam Medical Center in Haifa, Israel.

Results: Most participants (89 %) reported witnessing disruptive behavior either directly or in other parties; the most significant causes were identified as intense work, miscommunication, and problematic personalities. The forms of these behaviors, however, varied significantly between departments, with some more prone to expressed conflicts, while others were characterized by hidden disruptive behaviors. These outcomes were correlated by the antecedents to disruptive behavior, which in turn affected the effectiveness of alleviating strategies and tools. Some tools, such as processes for evaluating complaints, teamwork and conflict management courses, and introducing a behavioral mission statement, are effective across many antecedents. Other tools, however, are antecedent-specific, falling into two principal categories: tools directly removing a specific problem and tools that offer a way to circumvent the problem.

Conclusions: Conflict resolution tools and strategies, based on residents and nurse perceptions, may be more effective if tailored to the specific situation, rather than using a "one-size-fits-all" approach.